Oral mini‐pulse therapy in vitiligo: a systematic review

Abstract

Background There is limited evidence supporting the use of alternative treatments for patients with nonstable vitiligo.Objective This study aimed to review the effects of oral mini-pulse (OMP) therapy in the management of nonsegmental vitiligo. MethodsThe following databases were searched between inception and May 2020 for relevant studies: Scopus, Web of Science, MEDLINE, and Embase. All randomized controlled trials that compared OMP therapy with any other active treatment or placebo for nonstable vitiligo were included. The Cochrane's risk of bias tool was used to evaluate the risk of bias (ROB) in selected studies, and the overall quality of evidence of each outcome was assessed using the Grading Recommendations, Assessment, Development, and Evaluations (GRADE) system.Results Four studies met our selection criteria. All of them were conducted in India and included 246 patients. OMP therapy included betamethasone or dexamethasone. The duration of treatment was 6 months in all studies. Up to 32% of patients achieved a repigmentation rate of >75% when OMP therapy was administered as monotherapy. No difference was observed between OMP therapy and other treatments in arresting the disease, and weight gain was the most frequent adverse effect. The overall ROB in all included studies was relatively high because of the randomization process, outcome measurement and informed selection of outcomes. ConclusionBased on the findings of these studies, OMP therapy did not demonstrate additional value compared with other treatments. Hence, there is an urgent need to conduct high-quality clinical trials to evaluate this therapy.

Update on pharmacology, actions, dosimetry and regimens of oral glucocorticoids in dermatology

“…52 A recent systematic review examining studies on oral mini pulse in vitiligo found a high risk of bias and a low quality of evidence in the available literature. 53 The authors could not muster enough sound evidence to echo the claims of efficacy of OMP therapy in arresting disease progression and re-pigmentation in patients with nonstable vitiligo.…”

“…NB‐UVB and methylprednisolone 0.5 mg/kg on 2 consecutive days per week for at least 3 months has been found to produce a greater than 25% re‐pigmentation in 59.4% patients and was found to arrest disease progression in all patients 52 . A recent systematic review examining studies on oral mini pulse in vitiligo found a high risk of bias and a low quality of evidence in the available literature 53 . The authors could not muster enough sound evidence to echo the claims of efficacy of OMP therapy in arresting disease progression and re‐pigmentation in patients with nonstable vitiligo.…”

Arrest of progression and duration to achieve it: an important indicator for efficacy of medication aimed at rapidly progressive vitiligo

“…We read with interest the article by Chavez‐Alvarez et al. entitled “Oral mini‐pulse therapy in vitiligo: a systematic review.” 1 Oral mini‐pulse therapy, pioneered by Pasricha and Khaitan in the management of vitiligo, aims primarily at stopping the progression of the disease 2 . We noticed that as per the method of this review only four studies were included, and therefore some of the important non‐RCT studies could not be included in this review.…”

Oral pulsed high-dose dexamethasone therapy for rheumatic diseases: An alternative safe and effective scheme

“…Dexamethasone has been frequently used in oral administration due to its low mineralocorticoid action. Oral pulse therapy (OPT) has been commonly used in dermatology for alopecia areata, vitiligo, and alopecia Universalis, among others, with good results [ 2 , 3 ]; in neurology, it has been used to treat chronic inflammatory demyelinating polyneuropathy [ 4 ]. An exciting work by Luetic et al [ 5 ], from Argentina, that, in times of Covid, with the impossibility of performing conventional pulse therapy, OPT has been used to treat multiple sclerosis with good efficacy.…”